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Journal of the Korean Neurological Association 2008;26(2): 104-109.
해마경화증을 동반한 측두엽 간질에서 항경련제에 대한 반응성과 관련된 임상적 요인
양현우, 이 웅 정용태a 황태규b 김성은
인제대학교 의과대학 부산백병원 신경과학교실, 인제의대 신경외과학교실a, 인제의대 소아과학교실b
Clinical Factors Related With Response to Anti-epileptics in Temporal Lobe Epilepsy With Hippocampal Sclerosis
Hyun-Woo Yang
Department of Neurology, Neurosurgerya, and Pediatricsb, Inje University College of Medicine, Busan, Korea
Backgrounds: Temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is not always intractable to antiepileptic drugs (AEDs). To identify the responsiveness to AEDs and related clinical factors in TLE-HS, we performed this study.
Methods: Consecutive 100 (51 men, mean age=30.2±6.6, age range=19-50) patients with TLE-HS were divided into two groups by their responsiveness to AEDs. Intractable TLE-HS was defined if they had any seizures for the preceding year with at least two AEDs. Clinical factors were analyzed to find the association of the responsiveness to AEDs.
Results: Intractable TLE-HS was found in 68% of patients. The younger age of onset (12±4 vs. 31±8 years, p<0.0001), longer duration of epilepsy (17±6 vs. 2±1 years, p<0.0001), more than five tonic-clonic seizures (GTCs) with secondary generalization (29.4 vs. 6.3%, p=0.0009) and bilateral epileptiform abnormalities on EEG (30.9 vs 6.3%, p=0.0054) were significantly correlated with the intractable TLE-HS. According to multiple logistic regression analysis, bilateral epileptiform abnormalities on EEG (adjusted OR=9.4, 95% CI: 1.98~44.76) and more than five GTC (adjusted OR=7.7, 95% CI: 1.60~33.39) were independently related with poor responsiveness to AEDs in TLE-HS.
Conclusions: The presence of hippocampal sclerosis does not necessarily mean intractability to AEDs. The clinical variables related with the poor response to ADEs in TLE-HS are more than five GTCs and bilateral epileptiform abnormalities on EEG.KeyWords:Hippocampal sclerosis, Temporal lobe epilepsy, Pharmacoresistance